Healthcare Provider Details

I. General information

NPI: 1609468792
Provider Name (Legal Business Name): LIVELY STAFFING&HOMECAREAGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21171 S WESTERN AVE STE 2710
TORRANCE CA
90501-1728
US

IV. Provider business mailing address

21171 S WESTERN AVE STE 2710
TORRANCE CA
90501-1728
US

V. Phone/Fax

Practice location:
  • Phone: 424-229-4150
  • Fax:
Mailing address:
  • Phone: 424-229-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: FOLAKE OLAWUNMI OWODUNNI
Title or Position: OPERATING MANAGER
Credential: LICENSED VOCATIONAL
Phone: 424-229-4150